Fees paid to consultants working with ACC have more than tripled in the last four years.

The last financial year saw a hefty consultancy bill of over $58 million, according to figures released under the Official Information Act.

It’s a dramatic rise from the $17.5m spend during the 2013/14 year.

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Wed, 03 Jan 2018 23:44:39 +0000Dan Michalukhttps://allaboutinformation.ca/go/law-of-production-not-e-discovery/surreptitious-recording-of-ime-warrants-a-re-do/On December 28th, Justice Sweeny ordered a plaintiff to submit to another medical examination because he surreptitiously recorded a prior examination, commenting:

The surreptitious recording of the examination was improper. The effect of this recording is the doctor would now, most likely, be subject to cross-examination on issues as to what exactly happened in the course of the examination. The evidence of the plaintiff is also relevant. Mr. Cruz may be examined or cross-examined on the transcript. If the doctor was aware of the recording, he may have conducted his examination a different way. He may have been clearer in the language used. He may have been more specific is instructions given to the plaintiff. Much of the communication that goes on is nonverbal. The doctor was denied an opportunity to ensure that his words and conduct were being accurately recorded.

Most people when they hear about “junk science” assume that plaintiffs’ attorneys are trying to fabricate some pseudo-science to make out a case, usually in the context of a novel class action theory.

But those of us in the trenches know otherwise, that this isn’t the main problem. Junk science, on a day-to-day basis, is far more likely to spill from the mouths of defense experts in routine cases. I showed this a few years ago in a multi-part series dedicated to quickie medical exams by doctors hired by the defense. A three minute exam and presto! — a finding that the plaintiff either isn’t injured, or that any injuries s/he has were pre-existing.

Some doctors are doing 1,000+ exams per year like this in the service of the insurance defense industry, which is quite the living if you don’t mind sacrificing your conscience.

Today I turn my sights on the biomechanical engineer. This is the person that will generally look at the vehicles in a crash (not an accident), and deconstruct it in such a way to determine that the victim wasn’t really injured by it. Four years ago Justice Arlene Bluthdeconstructed that collision deconstruction for one such engineer, essentially showing the bogusosity of it all. (Is bogusosity a word? It should be.)

Last week the Appellate Division (Second Department) weighed in on that subject. And they were no more kind to the defense “expert” than Justice Bluth was.

Dovberg v Laubach was a hit-in-the-rear collision on the Long Island Expressway that pushed the plaintiff’s car into a tow truck in front of her:

The accident occurred when [the defendants’ vehicle] struck a vehicle operated by Scott Ramunni in the rear, propelling it into the rear of the plaintiff’s vehicle. The plaintiff’s vehicle was then propelled into a tow truck in front of her.

The key part of the story was how the plaintiff said that the injuries to her knees occurred — by striking the steering wheel or dashboard.

So far, nothing out of the ordinary, right? But then the defendants said they would produce Dr. Alfred Bowles as an expert, he being a biomechanical engineer and board-certified surgeon. And he would testify “that the force generated by the accident could not have caused any of the plaintiff’s alleged knee injuries, and that those alleged injuries were the result of wear and tear from athletic activities.”

And how would Dr. Bowles do that? By looking at the medical records and the depositions.

Really. According to the decision of the appellate court, that was what he would rely upon. Not even an analysis of the damage to the vehicles themselves? Or the position of the body? This is science?

Oh, and some books. As per the decision, Dr. Bowles would also rely upon:

scholarly works that were published in the fields of medicine and biomedical engineering, and had gained general acceptance in those fields. In support of this claim, the defendants listed the names of three works, which, according to their titles, involved head, neck, and mandible injuries. The authors, years of publication, and contents of these works were not set forth. [emphasis added]

The trial court permitted this dubious testimony to go forward, allowing him to testify “with a reasonable degree of engineering certainty, [that] the force generated by a low speed rear-end collision that propelled a vehicle into a 2000 Ford Taurus would not have caused the driver of the Ford Taurus to hit her knees against the dashboard.”

A defense verdict resulted on the issue of causation.

But on appeal the Second Department was, shall we say, less than impressed with this testimony. And this was likely the reason:

Although Bowles did not know how close the plaintiff’s seat was positioned to the steering wheel and dashboard at the time of the accident, he maintained that moving the seat up would not increase the likelihood of a driver’s knees hitting the dashboard in a rear-end collision.

So no one asked the plaintiff how far forward the seat was — which is to say the actual position of the injured driver — and then the expert testified that it didn’t matter? Distance to the dashboard didn’t matter? One inch and twelve inches are the same? Can you say bogusosity?

After a brief discussion of the long-recognized rule of Frye v United States — inthat expert testimony must be based on scientific principles or procedures and is admissible only after a principle or procedure has gained general acceptance in its specified field — the court swiftly deconstructed Dr. Bowles’ testimony.

The court noted that the

“expert disclosure notice simply stated that Bowles analyzed the medical and engineering aspects of the accident. While the defendants cited to three works in opposition to the motion in limine, they did not identify the authors, years of publication, and contents of those works, or any explanation as to their relevance in evaluating the cause of knee injuries. Moreover, the defendants provided no description of the methodology Bowles utilized to determine the force of the accident, and the biomechanical engineering principles he relied upon in reaching his conclusion that the force generated by the accident could not have caused the plaintiff’s knees to come into contact with the vehicle dashboard.

The court didn’t use the phrase “junk science,” or bogusosity, but I will. Because that’s the way I read this opinion. Your mileage may vary but, frankly, I don’t see how.

So the next time you hear about junk science, you should understand and appreciate that, on a day to day basis, this is not some plaintiffs’-side invention.

The essential business model of insurance companies is to collect as much as possible in premiums and pay out as little as possible (while investing the money in the interim). Many insurance companies, and adjusters, and their syncofantic witnesses who profit from this form of testimony, don’t seem to particularly care how that preservation of premiums is accomplished. Or who gets screwed by their process.

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Wed, 12 Apr 2017 10:03:18 +0000Jaya Dixithttps://collegescan.wordpress.com/go/uncategorized/check-top-medical-exams-list-2016-17-at-collegescan/Medical, is the science and practice of the diagnosis, treatment, and prevention of disease. The word “medicine” is derived from Latin medicus, meaning “a physician”. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.

It is not wrong to say that medical is one of the booming career nowadays in every respect. The majority of students appear every year for medical examinationsand consequently giving tough competition to each other.

Medical Exams:

Every year a number of medical examinations are conducted throughout the country in order to seek admissions in different medical courses. Exam conducting bodies are organizing different medical entrance exams at national as well as state level. If you are a medical aspirant then you need to get updated with all the upcoming medical exams. CollegeScan brings you all updates at one place, about the exams, eligibility criteria, pattern and counselling process of the exams.

Here, is the list of several medical exams held at national as well as state level:

It is the leading college comparison portal and career counsellor where you can search the best Medicalcollege sitting at your place. It is helpful for the students who are about to seek admission in different UG and PG courses. When it comes to college admissions, rankings, graduation rates, graduate school acceptance, college fees, courses and student satisfaction are available in a single click. The feature that makes collegescan unique from others is that students can simply fill the online form for different colleges by just registering to our site and we will do the best for you depending upon the eligibility and availability of seats in that college. Also, we bring for you the feature of calender where you can set reminders of the upcoming exams and also get notifications about that exam. User of our portal can get all the information about the upcoming exams, it’s whole pattern, eligibility criteria for that exam, online counselling procedure and much more information just sitting at your place. We are independent organization works to make higher education more available and affordable for people of all backgrounds. We help students achieve this by:

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Wed, 22 Mar 2017 00:17:24 +0000ppjghttps://ppjg.me/go/health/federal-quarantine-powers-quietly-expanded-without-congressional-approval/https://johnmitchk.wordpress.com/go/gender-issues/in-line-for-chest-reconstruction/
Tue, 21 Feb 2017 10:45:00 +0000johnmitchkhttps://johnmitchk.wordpress.com/go/gender-issues/in-line-for-chest-reconstruction/https://juicylinksmag.com/go/news-trends/rescued-chibok-girl-undergoes-medical-examinations-will-meet-buhari-today/
Thu, 19 May 2016 06:32:09 +0000Eddy Owasehttps://juicylinksmag.com/go/news-trends/rescued-chibok-girl-undergoes-medical-examinations-will-meet-buhari-today/https://42on42.wordpress.com/go/challenge/running-for-life-or-the-other-way-around/
Wed, 11 May 2016 20:47:52 +0000MsOhttps://42on42.wordpress.com/go/challenge/running-for-life-or-the-other-way-around/I have had a medical condition for some years, it comes and goes as it pleases with years inbetween. Last week it came back.

Five years ago I had it too and I went to see a doctor. He told me it was up to me if I wanted further examinations and investigations and most obviously digging and searching. I didn’t really say no, I said I’d think about it and I never went back. The doctor had quit and wasn’t working at the clinic the next time I went there and no one ever approached me with any concerns. The symptoms went away. I healed up and forgot.

Last week it came back. Like an old enemy you forgot about. But there it was. I decided not waiting but go to the doctor and get proper attention. I was there today. She couldn’t believe I ran for such long times and she understood my worries. She gave me the full examination and said I was alright. I’ll get some meds and I can keep running. I was so happy I almost cried.

In the car back home I thought about why I dared going thru with it this time and not before. Anxiety. Cancer. Life. Running.

The only conclusion I could cone up with was that the fear of not being able to run was bigger than the fear of a difficult medical examination.

My life have changed. I don’t look like a runner. I don’t feel like a runner. But I need running. I need to achive something. I need to know I can do it. That there’s something I can do that not every one else does. I think today I really discovered something important about myself…

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Fri, 04 Mar 2016 10:52:06 +0000Anne Babuhttps://kenyaemploymentlaw.com/go/constitution/employment-mandatory-medical-examination/https://blaneyscourtsummaries.com/go/uncategorized/court-of-appeal-summaries-june-22-26-2015/
Fri, 26 Jun 2015 21:01:48 +0000John Polyzogopouloshttps://blaneyscourtsummaries.com/go/uncategorized/court-of-appeal-summaries-june-22-26-2015/Hello everyone. Below are summaries of this week’s OCA civil decisions (non-criminal). There was a decision this week involving an interesting, but ultimately unsuccessful, claim for civil conspiracy in an airline pilot union dispute; the Court of Appeal confirmed that for a claim to survive bankruptcy under subsection 178(1)(d) of the Bankruptcy and Insolvency Act, any fraud, embezzlement, misappropriation or defalcation on the part of the bankrupt debtor must have occurred in the context of a fiduciary relationship with the creditor; there is an administrative law decision in the context of the setting of natural gas prices by the Ontario Energy Board; other topics covered include the power of the court to compel a plaintiff to undergo a medical examination and prescriptive easements.

Special mention goes to our own Ian Epstein who successfully resisted an appeal from a decision of a motions judge to dismiss the claim against our client as disclosing no reasonable cause of action.

Please feel free to share this blog with friends and colleagues. As always, we welcome your comments and feedback.

In the late 1980s, the trade union Canadian Airline Pilots Association (“CALPA”) initiated a process to merge pilot seniority lists at Air Canada and five regional airlines. An arbitrator ultimately composed the final list, which required Air Canada’s agreement to be implemented. Within days after the list was finalized, Air Canada pilots voted to leave CALPA and join a new union called the Air Canada Pilots Association (“ACPA”). The merged seniority list was not implemented. Air Ontario pilots launched a class proceeding against six sub-classes of Air Canada defendants alleging they had committed the tort of unlawful act conspiracy. The plaintiffs claimed damages for expenses incurred in creating the merged list and for the loss of chance to implement the list. The trial judge dismissed the plaintiffs’ claims and the plaintiffs appealed.

Issues:

(1) Did the “right to dissent” permit the defendants in sub-class six to frustrate the implementation of the arbitration award?

(2) Did the trial judge err in finding that the members of sub-classes two and four committed no unlawful acts?

(3) Did the trial judge err in her causation analysis?

(4) Did the trial judge err by not awarding merger expense damages of $150,280?

Holding: Appeal dismissed. The plaintiffs will pay the defendants costs in the agreed upon amount of $175,000, inclusive of disbursements and HST.

Reasoning:

To establish unlawful act conspiracy, a plaintiff must demonstrate that the defendants acted in concert by agreement or with a common design; the defendants’ conduct was unlawful; the defendants’ conduct was directed towards the plaintiff; the defendants should have known that damage to the plaintiff was likely to result; and the defendants’ conduct caused injury to the plaintiff. The second and last factors are contested here.

The Court of Appeal addressed the above issues as follows:

(1) The plaintiffs argued sub-group six breached the union contract by resisting implementation of the merged list and thereby acted unlawfully, which if found, would satisfy step two of the test for unlawful act conspiracy. However, sub-class six did not breach their contracts with CALPA by avoiding implementation of the arbitrator’s list. CALPA’s Constitution and Merger Policy did not expressly require their members to act to implement a merged seniority list, nor to refrain from impeding implementation of a list. Rather, as the trial judge found, CALPA and not the union members themselves had the primary responsibility for implementing the merger. Further, members of a union have the right to dissent against CALPA and union officials. Given the statutory right of union members to choose their union and the labour law principle affording them a right to dissent, this court will not read a term such as the one alleged by the plaintiffs into the union contract. However, note that sub-groups one through five did not have a right to dissent against the union because they were made up of union officers or members who worked on behalf of officers.

(2) The trial judge found that sub-groups two and four acted under the control and direction or others, and did not owe duties of loyalty to CALPA. She also said it was not clear that their conduct constituted a breach of contract. She ultimately found that they did not commit unlawful acts by breaching the union’s Merger Policy. The plaintiffs’ appeal argument did not address this key finding. The plaintiffs did not explain how the trial judge erred in her interpretation of the Merger Policy.

(3) The plaintiffs argued that the trial judge erred in concluding that, even without the defendants’ unlawful acts, the chance of implementing the merged seniority lists was not more than de minimis. They argued the trial judge should have speculated about what would have happened if CALPA’s single employer application had been successful; they believed that if the application had succeeded, the chance of implementing the list would have been real and significant. However, the defendants were not required to support a single employer application. The Merger Policy did not call for or require a Simple Employer application. The judge was only required to consider what would have happened but for the defendants’ wrongful conduct. She was not required to speculate about what would have happened but for lawful conduct. Therefore, she was correct that it was not appropriate to speculate that the Board’s decision may have been different in the single employer application if the Air Canada pilots had supported the application.

(4) The trial judge found that the defendants should have known that injury to the plaintiffs was likely to result from their unlawful conduct. She also found that the plaintiffs’ merger expenses were $150,280. However, she concluded that regardless of their conduct, the merged seniority list would not have been implemented. The plaintiffs did not establish that the defendants’ wrongful conduct caused the loss of the plaintiffs’ merger-related expenses. Therefore, they were not entitled to the merger expenses.

Korea Data Systems USA (“KDS USA”) and Korea Data Systems Korea (“KDS Korea”) sued ATC, Aamazing and the Chiang brothers in California, for breach of a settlement agreement and amounts owed on unpaid invoices. The Chiang brothers were held personally liable to KDS Korea for the outstanding amount owed under the settlement agreement. The California court did not find that either of the Chiang brothers owed a fiduciary duty to KDS Korea or KDS USA or that they had breached such a duty.

Jay Chiang filed for bankruptcy in Ontario, and declared the California judgment as a liability. KDS and KDS USA sought a declaration that Jay Chiang’s debt under the California judgment would survive his discharge from bankruptcy under ss. 178(1)(d) of the Bankruptcy and Insolvency Act (“BIA”). The KDS companies obtained leave under the BIA to continue the Enforcement Action against Jay Chiang and to enforce any judgment obtained, on the basis that Jay Chiang’s judgment debt to them was grounded in fraud.

Subsection 178(1)(d) of the BIA provides that an order of discharge does not release the bankrupt from “any debt or liability arising out of fraud, embezzlement, misappropriation or defalcation while acting in a fiduciary capacity or, in the Province of Quebec, as a trustee or administrator of the property of others.”

The trial judge held that ss. 178(1)(d) applies only if the bankrupt owed a fiduciary duty to the creditor who seeks relief under ss. 178(1)(d). Since Jay Chiang owed no fiduciary duty to KDS USA, ss. 178(1)(d) was not available to that company to obtain a declaration that his debt to it under the California judgment would survive his discharge from bankruptcy.

Issues:

Whether the trial judge’s construction of ss. 178(1)(d) of the BIA was correct.

The trial judge’s interpretation of ss. 178(1)(d) comports with the purposes of the BIA: the equitable distribution of a bankrupt’s assets among creditors inter se and the financial rehabilitation of insolvent individuals.

The exceptions set out in ss. 178(1) are to be construed narrowly and applied only in clear cases. A creditor cannot bring its claim within the exception set out in ss. 178(1)(d) when that claim arose out of the bankrupt’s breach of a fiduciary duty to a third party. To hold otherwise would expand the reach of ss. 178(1)(d) beyond what it exists to protect – the relationship between a vulnerable creditor and a fiduciary debtor.

The purpose of ss. 178(1)(d) is to prevent a bankrupt from avoiding debts and liabilities to a vulnerable creditor where the bankrupt was entrusted, in a fiduciary capacity, with money or property belonging to that creditor. The law imposes obligations on fiduciaries to protect only those beneficiaries to whom fiduciary obligations are owed.

Subsection 172(2) and s. 173 of the BIA seek to ensure that dishonest debtors do not benefit from dishonesty by requiring the court to refuse or suspend a bankrupt’s discharge in bankruptcy, or to grant a discharge on terms. The existence of a breach of a fiduciary duty is not a prerequisite to the application of these sections. Accordingly, it was unnecessary to expand the scope of the term “fiduciary capacity” in ss. 178(1)(d) in order to prevent a bankrupt from profiting under the BIA from his or her own fraud or fraudulent breach of trust.

Subsection 178(1)(d) is available to a creditor of a bankrupt if the bankrupt has abused his or her fiduciary position with the claiming creditor by incurring a debt to the creditor through fraud, embezzlement, misappropriation or defalcation, in violation of the bankrupt’s fiduciary duty to the claiming creditor.

A successful claim under ss. 178(1)(d) requires two elements: i) the debt at issue must be linked to the bankrupt’s fraud, embezzlement, misappropriation or defalcation; and ii) the fraud, embezzlement, misappropriation or defalcation must occur in the context of a fiduciary relationship. The second element was not satisfied in this case. The decision in the California court contains no finding that Jay Chiang owed or breached any fiduciary duty in respect of either KDS company, and KDS USA concedes that Jay Chiang did not owe it a fiduciary duty.

In 2007, Union Gas entered into an Incentive Regulation Mechanism (“IRM”) Agreement with parties representing its major stakeholders and constituents (the “interveners”) to provide for a five-year period of incentive regulation. By order made in January 2008, the Ontario Energy Board (the “Board”) approved the IRM Agreement. The IRM Agreement contained an Earnings Sharing Mechanism (“ESM”), under which Union Gas agreed to share utility earnings greater than two per cent above its regulated rate of return with ratepayers.

As part of the IRM Agreement, Union Gas agreed to reduce its revenue requirement by $4.3 million. In exchange for this reduction, four deferral accounts previously established by the Board were eliminated. As a result of the elimination of the four deferral accounts, under the IRM Agreement, Union Gas was able to keep net revenues that would previously have been recorded in those accounts, subject to the ESM.

In April 2012, Union Gas applied to the Board for an order amending the rates it would charge to its customers for natural gas as of October 2012. Union Gas’ April 2012 application for a rate order included a request to share with ratepayers $22 million in 2011 revenues Union Gas had earned using TransCanada Pipelines Limited’s (“TCPL”) Firm Transportation Risk Alleviation Mechanism (“FT-RAM”) program under the ESM. Union Gas classified its 2011 FT-RAM earnings as upstream transportation optimization revenues – that is, as utility earnings that would previously have been recorded in one of the eliminated deferral accounts.

During Union Gas’ 2012 application, the Board directed that Union Gas’ classification of its 2011 FT-RAM revenues be dealt with as a preliminary issue in the proceeding. The Board found that Union Gas had used the FT-RAM program to generate profits on its upstream transportation portfolio on a planned basis – whereas Union Gas’ past upstream transportation optimization activities had occurred on an unplanned basis. The Board rejected Union Gas’ classification of its 2011 FT-RAM revenues as utility earnings and concluded instead that the disputed $22 million should be classified as “gas supply cost reductions”. Though gas supply cost reduction revenues would ordinarily be passed through to ratepayers, the Board directed that 90 per cent of the revenue should be credited to ratepayers and that 10 per cent should be credited to Union Gas as an incentive for generating the revenues.

Union Gas appealed the Board’s decision on the preliminary issue to the Divisional Court. In a split decision, the Divisional Court found that the Board’s decision was reasonable.

(1) Was it reasonable for the Board to decide to treat Union Gas’ 2011 FT-RAM revenues as encumbered and therefore subject to further disposition by the Board in the form of a credit to ratepayers?

(A) Did the Board’s decision contravene the principle against retroactive ratemaking?

(B) Was it reasonable for the Board to decide that Union Gas did not treat the upstream transportation optimization revenues appropriately in 2011 in the context of Union Gas’ existing IRM framework?

Holding: The appeal is dismissed. Neither party requested costs and none are awarded.

Reasoning:

(1) Yes, the Board’s decision was reasonable. Decisions of the Board are reviewable on appeal to the Divisional Court on a standard of reasonableness.

The Board’s decision was nothing more than a review of the nature of the revenues brought forward for sharing under the ESM and a determination that some of such revenues did not qualify for that treatment. Accordingly, the Board’s decision cannot be seen as unreasonable on the basis that it was a departure from the IRM Agreement. Nor was its conclusion that the FT-RAM revenues did not qualify for sharing under the ESM unreasonable.

In these circumstances, where the ESM determination was inherently retrospective, and where Union Gas failed to disclose in advance the true nature of its intended 2011 FT-RAM activities, it was not unreasonable for the Board to treat Union Gas’ 2011 FT-RAM revenues as encumbered and therefore subject to further disposition by the Board in the form of a credit to ratepayers.

(A) No, the Board’s decision did not contravene the principle against retroactive ratemaking. Generally, absent express statutory authorization, a regulator such as the Board may not exercise its rate-making authority retroactively or retrospectively. This rule exists because retroactive ratemaking redistributes the cost of utility services by asking today’s customers to pay for the expenses incurred by yesterday’s customers.

In Bell Canada v. Bell Alliant Regional Communications, Abella J held that the disposition of funds in a deferral account for one-time credits to ratepayers did not constitute impermissible retroactive ratemaking. In particular, Abella J. stated it was known from the beginning that funds accumulated in the deferral accounts at issue were subject to further disposition by the regulator in the form of credits to ratepayers.

More recently, in Atco Gas, the court explained that “[s]imply because a ratemaking decision has an impact on a past rate does not mean it is an impermissible retroactive decision”.

Union Gas knew, from the outset of the IRM Agreement, that the Board’s ESM determination would impact rates. The ESM determination under the IRM Agreement was thus inherently retrospective – and Union Gas always knew that.

The fact that the FT-RAM revenues were not segregated in a special deferral account relating specifically to gas supply cost reductions does not mean that the Board engaged in impermissible retroactive ratemaking by reclassifying them as gas supply cost reductions. Rather, the FT-RAM revenues brought forward by Union for disposition as part of the ESM proceeding were effectively “encumbered” and subject to further disposition by the Board.

(B) Yes, the Board’s decision that Union Gas did not treat the upstream transportation optimization revenues appropriately in 2011 in the context of Union Gas’ existing IRM framework was reasonable.

The Board’s findings that monies generated by Union Gas’ 2011 FT-RAM activities were generated on a planned basis, and were thus distinguishable from upstream transportation optimization revenues that would have fallen within the eliminated deferral accounts. These were findings of fact that were not subject to review on appeal to the Divisional Court.

The Board made a specific finding that a clear distinction can be made between Union’s unplanned transactional services and Union’s planned FT-RAM activities. As such, the Court agreed with the Board that in circumstances where Union Gas knew that it was generating its 2011 FT-RAM revenues on a planned basis, Union Gas must be fixed with knowledge, as of the date it generated those revenues, that the Board would be obliged to characterize them as a Y factor, or pass-through item, under the IRM Agreement.

Although the Board had permitted profit-taking on optimization activities in the past, on the Board’s findings, the prior optimization activities involved disposing of unplanned surpluses of firm transportation. The 2011 FT-RAM activities were qualitatively different because they involved disposing of planned surpluses of firm transportation. Prior to the 2012 hearings, Union Gas was the only party in a position to know that – and must also be taken to have known that – its actions were inconsistent with the regulatory principle inherent in the IRM Agreement.

While the Board may not have expressly stated that Union Gas was acquiring excess firm transportation during 2011, this message was clear on a fair reading of its decision on the preliminary issue in combination with its decision on the 2012 cost of service proceeding.

Alexander Ziebenhaus (the “appellant”) was injured while skiing on a school trip at the Mount St. Louis Moonstone Ski Resort. He allegedly suffered a brain injury and has claimed damages for loss of future income and loss of competitive advantage in the workplace, as well as other heads of damages (no pun intended). Counsel for the appellant arranged for a neuropsychological and psychovocational assessment. The resulting report stated that his vocational potential and ability to pursue competitive work were “guarded”. Mount St. Louis Moonstone Ski Resort Ltd. (the “respondent”) wanted Ziebenhaus to undergo another vocational assessment by an assessor it had selected. It accordingly brought a motion for an order to that effect. The motion judge allowed the motion.

The parties agree that a vocational assessor is not a “health practitioner” as defined in ss. 105(1) of the Courts of Justice Act (“Act”) and that there is no provision in the Act or in the Rules of Civil Procedure empowering a court to order that a party submit to an examination by a vocational assessor.

The motion judge’s order was appealed to the Divisional Court. That court affirmed the order. It agreed with the motion judge’s holding that the Court has inherent jurisdiction to order assessments and examinations not specifically addressed by s. 105 of the Act.

Issue:

Did the Divisional Court err when it affirmed the motion judge’s decision that the Superior Court of Justice has inherent jurisdiction to order a party to undergo an assessment by someone who is not a “health practitioner”, as defined in s. 105 of the Act?

Holding:

Appeal dismissed. By agreement of the parties, the respondent would be awarded costs on a partial indemnity basis, fixed in the amount of $25,000, inclusive of disbursements and HST.

Reasons:

No. There is no basis to interfere with the Divisional Court’s decision. That court fully canvassed the submission that an order for examination by an individual who is not a “health practitioner” would be contrary to the intent of s. 105 of the Act. In doing so, that court also addressed the conflicting lower court jurisprudence on the issue of the court’s jurisdiction to order such an examination. Previously, one line of cases interpreted s. 105 of the Act and Rule 33 narrowly, allowing courts to order such an examination only if a health practitioner required it as a diagnostic aid. The other line of cases suggested that a court could exercise its inherent jurisdiction to order such an assessment, to ensure justice between the parties is done.

The language of s. 105 and Rule 33 does not constitute such clear and precise language. The language of these provisions is permissive, and they do not state that a court cannot order an examination by someone who is not a “health practitioner”. The Divisional Court was correct in concluding that the health sciences and patient care have evolved to include a wide range of assessments by experts who are not “health practitioners”. Such assessments cannot all be characterized as diagnostic aids to the opinion of a “health practitioner”. Precluding their use in the litigation context would be contrary to good public policy.

Facts:The appellant owned 842 King Street West, which abuts a right-of-way leading to a public lane depicted in the sketch. The respondent owned the four properties known municipally as 844-850 King Street West, as well as the right-of-way directly behind them.

The appellant’s application for a declaration that it had a right-of-way over the private laneway behind 844 to 848 King Street West was dismissed. The application judge concluded that the appellant’s predecessors in title had not acquired a prescriptive easement over the laneway on the basis that “there was more than 20 years of use of the private right-of-way but the use was by licence and not as of right.”

Issues:

Whether the appellant’s predecessors in title to 842 King Street West acquired from the respondent’s predecessor in title a prescriptive easement over the depicted right-of-way.

Holding: Appeal allowed.

Reasoning:There is no evidence to support the application judge’s factual finding that the respondent’s predecessor in title permitted his neighbours to cross over his property by way of licence and not as of right.The appellant’s application for a prescriptive easement was on the basis that its predecessors in title exercised a continuous, uninterrupted, open and peaceful use of the private laneway as a right-of-way for vehicular and other traffic from the rear of its property westward to the public laneway, without the owner’s express consent, for over 20 years before the first registration of the property in the Land Titles System in 2003, taking into account s. 31 of the Real Property Limitation Act, R.S.O. 1990, c. L.15

Once the appellant had proven facts that support the inference of acquiescence in 20 years of use, the evidentiary burden passed to the respondent to lead evidence to rebut the inference by proving the use was by permission. The evidentiary record is that the appellant’s predecessors in title had used the laneway in a continuous, uninterrupted, open and peaceful manner without objection by Mr. Chan for over 20 years. This evidence gives rise to an inference of acquiescence by Mr. Chan. As there was no evidence to rebut the inference, the application should have been allowed.

The applicants, Osztrovics Farms Ltd. (“OFL”), Elysia Osztrovics and Violet Osztrovics (collectively the “Osztrovics Applicants”), sought leave pursuant to ss. 193(e) of the Bankruptcy and Insolvency Act (“BIA”), to appeal from the order of Wilton-Siegel J. (the “Order”). The Order dismissed the Osztrovics Applicants’ appeal from the order of Registrar Short and granted the cross-appeal of PricewaterhouseCoopers Inc., the Trustee in bankruptcy of the estate of Victor Osztrovics (the “Respondent”). The estate of Victor Osztrovics holds shares in OFL.

OFL operates a tobacco farm. Elysia and Violet are directors of OFL, as was the bankrupt, Victor, prior to his bankruptcy. On November 20, 2012, the Trustee wrote to OFL’s counsel requesting all information and documents relating to OFL’s operations. The Osztrovics Applicants refused that request. The Registrar concluded that the language of ss. 163 and 164 was sufficiently broad to encompass documents of a corporation respecting its business and ordered the disclosure of the information. The Registrar also ordered the examinations of Elysia and Violet for the same reason.

The Applicants appealed the Registrar’s order, and the Trustee cross-appealed that part of the order, which required Violet to answer written interrogatories instead of submitting to an oral examination. The motion judge dismissed the Osztrovics Applicants’ appeal, granted the Trustee’s cross-appeal, and set aside the Registrar’s costs order, instead awarding the Trustee its partial indemnity costs.

Issues:

(1) Did the motions judge err by interpreting the Trustee’s right to access under BIA ss. 163 and 164 as one which entitled the Trustee “to disclosure from a private corporation of such information as is relevant to permit a valuation of shares of a bankrupt in such corporation”?

(2) Did the motions judge err by finding no operational conflict exists between the OBCA s. 134 and the BIA ss. 163 – 164?

(3) Did the motions judge exceed his jurisdiction as an appeal judge by setting aside the confidentiality agreement in the Registrar’s order, since that term of the order was not under appeal?

(4) Did the motions judge err by authorizing the examination of Violet and requiring that the examination be an oral one, instead of one conducted by way of written interrogatories?

(5) Did the motions judge err by interfering with the Registrar’s costs decision?

Holding: The appeal is dismissed. The partial indemnity costs of $12,180.68 sought by the Trustee on this leave motion are too high. A fair and reasonable award of costs to the Trustee is $6,000.

Reasoning:

(1) No. In this case, the issue raised by the applicants concerning the scope of BIA s. 164 is not prima facie meritorious. BIA s. 164(1) authorizes a trustee to require a person to produce any documents or records in his possession “of any kind relating in whole or in part to the bankrupt, his dealings or property.” The motions judge found that a Trustee is entitled to disclosure from a private corporation of such information as is relevant to permit a valuation of shares owned by a bankrupt in such corporation. There is no viable argument that the motions judge erred in affirming the Trustee’s authority to demand the information sought from OFL in the specific circumstances of this case.

(2) No. It was the Registrar who first raised the issue of the possible application of the doctrine of federal paramountcy, but he concluded that no operational conflict existed. Putting to one side the question of why the applicants would wish to raise this as an issue on appeal when a finding of operational conflict would result in the federal legislation – i.e. BIA s. 164 – prevailing, there is no viable argument that the motion judge erred in principle when he concluded that there is also no conflict between the provisions of s. 134 of the OBCA and the BIA. As the Appellants note, s. 134 merely codifies the obligations of directors to act in the best interests of a corporation. Any determination that directors may make regarding the best interests of a corporation is necessarily restricted by the obligation of the corporation to comply with statutorily mandated powers, whether derived from federal or provincial statutes.

(3) No. There is no merit in this argument: the Osztrovics Applicants’ Notice of Motion by way of Appeal asked to set aside the Registrar’s decision in its entirety. Accordingly, the motions judge had the jurisdiction to set aside the confidentiality agreement.

(4) No. The Registrar determined “Violet was a ‘person who had knowledge of the affairs of [the] bankrupt’,” and the applicants advance no argument as to how the Registrar erred in making that finding of fact. Further, the Trustee made its initial demand for information about OFL on November 20, 2012. Over the past 2.5 years the Osztrovics Applicants have refused to provide the requested information. Their refusal has prevented the Trustee from valuing the most important asset in the bankrupt’s estate – his shares in OFL. To permit an appeal would further delay the administration of an estate whose affairs already have been impeded unduly by the applicants’ refusals.

(5) No. Regardless of any merits in that argument, the correctness of the costs award does not raise an issue that is of general importance to the practice in bankruptcy/insolvency matters or to the administration of justice as a whole.

The appellant, Rhonda Starkman, owns a residential property in Toronto over which Home Trust Company holds first and second mortgages. The first mortgage matured in April 2014 and was not renewed or repaid. The second mortgage secured an Equity Line Visa Card and was payable on demand. In December 2010, Home Trust was granted default judgment in respect of the debt due under the second mortgage and in March 2011 it obtained a writ of possession for the property. It did not act upon the writ at that time.

In June 2011, Starkman commenced this action against Home Trust, calling into question the accuracy of the calculations as to the amounts owing under the mortgages. Home Trust counter-claimed and successfully moved for summary judgment for possession of the property and a declaration of the amounts owing under both mortgages.

Starkman moved on an urgent basis for relief which amounts to a stay of the execution of the writ of possession pending the hearing of her appeal and the setting aside of the Sheriff’s notice to vacate the property.

Issues:

Should Starkman be granted a stay of the enforcement of the writ of possession pending her appeal?

Holding: Motion dismissed.

Reasoning:

To obtain a stay of judgment pending appeal, Starkman had to satisfy the three part test set out in RJR-McDonald Inc v Canada (AG) (1994): (1) there is a serious question to be determined on the appeal; (2) she will suffer irreparable harm if the stay is denied; and (3) the balance of convenience favours granting a stay.

(1) Serious question: Starkman submitted in her appeal two serious questions in respect to the issuance of a writ of possession: 1) that the Sheriff’s notice to evict was defective in form, and 2) that the motion judge erred in satisfying that all persons in actual possession of the property had been notified. The judge found that the first submission amounted to a clerical error, and not one that would mislead Starkman. Accordingly, the notice to evict was found to be operative. The judge then found that, though Starkman alleged that it was her adult children that were in possession, the evidence contradicted this submission. One child lives in British Columbia and the other is at Queen’s University. In any event, the children had known since February of 2011 of Home Trust’s attempts to take possession of the property.

(2) Irreparable harm: The judge found that Starkman faced the prospect of losing her property solely as a result of promises she had made to Home Trust. Starkman had borrowed money from Home Trust on the security of the mortgages. She had agreed that if she defaulted on her obligations to repay the mortgage, the mortgagees could take possession of her property. Thus the judge did not find irreparable harm.

(3) Balance of convenience: The balance of convenience favoured Home Trust. Starkman had admitted significant indebtedness and arrears to Home Trust, and she has not made a mortgage payment in over four years.

For these reasons the judge found that it would not be in the interests of justice to grant Starkman a stay of the enforcement of the writ of possession.

The information contained in our summaries of the decisions is not intended to provide legal advice and does not necessarily cover every matter raised in a decision. For complete information or for specific advice, please read the decision or contact us.

She had a loss of money and after that a profit from money by documents(shares,sales).

She wasn’t finacialy worried – she closed part of her money. She invested her money in a real estate with a thought for the future. She was pleased and relieved. She didn’t wanted to live on a high place – apartment. She was prepared to travel with aircraft.

She had a medical examinations and meeting with five doctors.

Medical (Health) Diagnosis by Clairvoyant Dimitrinka Staikova :

(20.01.2015 – 3.02.2015)

Disease in the pituitary, behind the left eye,disease in the thyroid gland. The heart reacted (it wasn’t sick) and the liver (it wasn’t sick). Down low in the stomach i see a scar on the right side – forthcoming surgery intervention of malignancies – on the right side of the genitals.

Bobbi Kristina Brown was worried if she will be able to have children. She wasn’t strong enough to meet the hard dianosis of the doctors- cancer in the right ovary.

Now – there are pains in the body by the muscles in right,in the left eye,thyroid gland and genitals in the right side.

The secret about awakening is the spine in the cervical vertebrae. She hit lightly her head

at the back left side (the edema is there) and now is the liver – overloaded with chemicals (medicines) – Now ,the hardest is the pain in the liver and the right kidney and two edemas one in the other at the back side of the head from the left and the right side.

It is rather surprising how little concrete information one can obtain now about military medical examination procedures in the First World War. Recurrent themes are how perfunctory they were, the high percentage of young men who were rejected in 1914 as medically unfit, and an obsession with height.

George had no difficulty with the basic demands of the Army medical, as he had satisfied them back in August 1914. He was five foot nine and a half inches tall (the minimum was five foot three), had an expanded chest measurement of forty inches (the minimum was thirty-four), reasonable teeth, excellent vision, and ‘Good physical development’. Obviously, though, the question was how well, at the age of forty-six, had he recovered from his smashed fibula of two months ago? Did he mention the trouble he had had with his prostate gland? Was the latter cured, or was it something more sinister?

Without a doubt, if he had not worked on his physical condition with the exercises, professional massage and private medical care, he would not have been passed for active service in the Corps of Interpreters. This was because since George went to Windmill Hill Camp in September 1914 interpreters had become essentially orderlies. They had to run, and they had to be able to run fast. The group of young interpreters who superseded George around Colonel Gordon Wilson at Zillebeke in November 1914 were so active that they were nicknamed ‘the football team’.

Conversely, by January 1915 the Corps of Interpreters had become part of the nascent British Intelligence Service, and George could have found work in that. His linguistic, analytic, mathematical and cryptographical skills could have been invaluable. This is in fact what the ‘Godfather in War’, George’s friend at the War Office Sir Coote Hedley, wanted him to do: to ‘work away from the firing line’.

But Calderon had taken every step to pass the medical for active service. In Kittie’s view, ‘his strength of purpose was such that he simply hypnotised the Medical Officer into believing him fit’…

Decompression sickness is the medical condition arising from dissolved gases coming out of the bloodstream and producing bubbles within the body. This condition is also known as the Bends.

These bubbles can migrate within the body and cause joint pain, paralysis and even death. The most common symptom is local joint pain. Pain in the arms is twice as frequent as pain in the legs. Almost all of the decompression sickness occurs within the first eight hours.

There are various forms of decompression sickness including arterial gas embolism and barotrauma. Some of the most severe conditions arise when air bubbles form in the central nervous system, spinal cord, or brain. There are so many manifestations of decompression sickness that almost any symptoms occurring after diving could be explained as a consequence.

We typically think of decompression sickness is occurring in scuba divers. However, this also occurs to astronauts when they perform a spacewalk and the pressure in the spacesuit is lower than the pressure in the spacecraft.

Pilots and passengers may also experience a form of decompression sickness when in on pressurized aircraft ascends to high altitude. However, the form with decompression sickness that relates to flying soon after scuba diving is in many ways most problematic. This is frequently occurring when vacationers try to fit in one more scuba dive before heading back home. Sometimes they forget that this is a major risk to their health.

In fact there are specific recommendations from the diver alert network That you should not fly within 12 hours of completing the single dive were 18 hours of doing multiple dives and were possible to wait 24 hours.

So let’s all be safe and do our dog it’s at least a day before we leave to fly back home. Of course this makes it difficult for commercial pilots on short layovers to go scuba diving, but that is part of the demands of the profession.

Pilots are concerned about a new medical standard for Obstructive Sleep Apnea (OSA) by the Obstructive Sleep Apnea (OSA). The concern is that pilots with a serious weight problem will be adversely affected in their recertification. I would like to present my perspective as a senior AME. My thoughts are my own and not necessarily shared by the powers that be.

Obstructive sleep apnea may cause functional impairment for safe aircraft operations. OSA literally means that someone stops breathing during sleep or effectively loses the ability to oxygenate the blood stream. This is because the upper airway is partially or completely blocked during sleep. Therefore the chest muscles and diaphragm must work much harder to open the airway and maintain respiration.

Sometimes a spouse or significant other will notice that during sleep an individual has difficulty maintaining normal respiration or, in fact, there are long pauses between breaths. Patient will come to the office with this clear witnessed account of sleep apnea and we request that a sleep study be done. This involves going to a sleep lab and spending the night while being monitored.

However doctors also should be looking for symptoms of daytime sleepiness, excessive fatigue, non-restorative sleep, difficulty concentrating, forgetfulness, snoring, and inability to stay awake during common activities during the day.

Overwhelmingly the patients at risk for this are not aware of the condition. Therefore, prospective screening is the best way to diagnose and manage patients with OSA. There are estimated to be more than 12 million people in the United States at this time with sleep apnea. More than half of those individuals are overweight. It tends to occur in middle-age man and older woman. The risk factors for obstructive sleep apnea include obesity, thick or large next, and smokers.

The FAA’s concerned that OSHA will result in impaired pilot performance. The FAA has published the Guidelines indicating that mild to moderate obstructive sleep apnea can show performance degradation equivalent to 0.06 to 0.08% blood alcohol levels which is the measure of legal intoxication in most states. There’s also the increasing risk of hypertension and atherosclerosis with the resulting increasing the risk of heart attack and stroke. In fact 30 to 50% of patients with heart disease and 60% of patients suffering strokes are found to have obstructive sleep apnea.

The FAA medical guidelines indicate that OSA is present in almost all obese individuals with a body mass index over 40 and the next circumference greater than 17 inches. Untreated obstructive sleep apnea is a disqualifying condition for airmen and air traffic control specialists.

The next steps in the process will be for the pilot to have a BMI and neck circumference measured during the medical examination. Those airman with high BMI above 40 and neck circumference greater than 17 will be asked to undergo specialized evaluation by a sleep disorder specialist.

Currently all classes of airman with the diagnosis of obstructive sleep apnea require special issuance. Airmen may be returned to flying after receiving special issuance based upon all pertinent medical information and current status report to include a sleep study with polysomnogram, use of medication, and titration study results for the CPAP machine.

One of the criteria to maintain special issuance is verification from the patient and his treating doctors that the use of the treatment device called a CPAP machine is being done on most nights and a record of compliance is documented.

In my practice I am advocating intensive weight-loss treatments to preclude the need to go through the OSA special issuance process.

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Mon, 13 Oct 2014 12:38:14 +0000MyFlightMDhttps://myflightmd.wordpress.com/go/aircraft/duration-of-faa-pilot-medical-certificates/Many pilots ask if we could recap the duration for their medical certificates. and the frequency for the EKG for the first class airmen.

Order Your Full (Detailed ) Psychic Life Reading on email by Clairvoyant/Psychic Dimitrinka Staikova (Author of more than 30 books with World Predictions and Psychic Readings of Celebrities published in Amazon).

Price

for Clairvoyant reading :

Clairvoyant Health Diagnosis on Email – 35 Euro –

THIS OFFER IS NO LONGER AVAILABLE

!

The price of Detailed/Full /Clairvoyant /Psychic Reading that include health diagnosis is 100 Euro

Clairvoyant Life reading on Email -100 Euro

Royal Clairvoyant Life Reading on Email – 200 Euro –

The Conditions for Clairvoyant life reading on email and Clairvoyant health diagnosis are below :

2.Тhe Psychic Reading (consultation) will be made three days after we receive the details of the transaction.

After the payment,you must send actual photo (if possible made in the same day of the order)-you will receive the text of your psychic reading on your email, after that You can ask your additional questions On email:

dimitrinka.staikova@gmail.com

Send Your additional questions until 48 hours after You receive Your Clairvoyant/Psychic reading on email. The additional questions are free and if You don’t send them until 48 hours, You loose this free option.

Please, do not send explanations or details in additional questions!

3.The payment is about Full Clairvoyant/psychic reading is 100 euro – including Clairvoyant Health diagnosis and complete information about the life – the past and the future of the client.

Тhe payment is accepted as donation (this must be noticed in the money transaction ). We accept the donation for building a well with healthy water.

If clairvoyant mrs. Dimitrinka Staikova refuse to make a consultation to a person the donation will be back to the person without the tax of the transaction. The consultation can be refused only from the clairvoyant.

The consultation is personal -only for the person who has made the payment . You may ask additional questions in the end of the consultation.

After the order, send Your today’s photo on our email : dimitrinka.staikova@gmail.com .You will receive Your Full Psychic Life Reading in the next 24 hours after the order, after that You can ask additional questions, which are included in the price. Please, do NOT include explanations in the additional questions.

My Motto is – Everyone is what he thinks about itself. Example – I am good, compassionate, I help to the people, I’m searching only the good in them, I suffer with them, I show the way through which they will pass and what is their destiny. I see how to be avoided (locked) the bad magic, I see the divine light in the person, I help the destiny to be followed.

I discover the way of the bad moments in Your life caused by compromises, magic or genetically determined – I show the destiny and give advices. My Words, My Clairvoyant Predictions and My Psychic Readings come true, because I bring to the people only Peace and Love.

My feet are planted firmly on the ground.

The sun that shines me shows my shadow.

God, who sees my soul ,hears my voice. I travel in the unreal world, to return in the real with Your answers about the Life.

Love Your Self and God will love you too.

By Clairvoyant House “Dimitrinka Staikova and Daughters Stoyanka and Ivelina Staikova” – from Europe, Bulgaria, Varna.

You can find all conditions to order Your Clairvoyant/psychic reading (consultation).

Im working only Online-in Internet,I dont meet my clients personally.

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Thu, 02 Oct 2014 16:51:57 +0000whyinsuredhttps://whyinsured.wordpress.com/go/uncategorized/insurance-without-medical-exam/With the boom in the insurance market there has been a cutthroat competition between the insurance companies and in today’s time getting insured has become much easier. The term policy is the perfect example which provides sufficient death benefit and a financial support to the beneficiaries in case of the death of the policy holder within the tenure of the policy but gives no provision of cash value. Now comes the question that is term insurance flexible enough to fit into the bill of every insurance buyer? Definitely it is not and some rules prevent many to buy these policies. Here comes the life insurance no exam policies in the picture because it is the best thing that all those who are not fulfilling the eligibility criteria can opt for.

When it comes to factors associated to the above mentioned option of insurance then it is not one but there are many factors. In order to enjoy these services and buy life insurance no exam policies the people fulfilling the eligibility criteria should be through with the terms and conditions of this special category of insurance. To top it up the underwriting process of the policy is designed to be very simple and that makes it more flexible for the insurer to get insured without any complications. Because one is not subjected to a medical examination in this case one can skip the medical information bureau (MIB) record as well.

WHEN DO WE START HOLDING OBAMA AND THIS WORTHLESS GOVERNMENT ACCOUNTABLE?

The government is reminding public schools that they must enroll undocumented (illegal) immigrants, that it is federal law. Okay, I’ll give them that; however, they want school districts to abide by this law, to follow the law. The government expects everyone else to abide by the law, but the government is exempt from following the law? Case in point, it is the law that these same undocumented (I guess that is the politically correct term for illegals today) immigrants are subject to a medical screening process; however, this law is being ignored under the Obama administration. Gee that is shocking, he is the lawless president! See below:

Federal law subjects legal immigrants to a medical screening process (and even has health safety rules covering the importation of animals). These rules are not being applied to illegal immigrant children.

The federal government is, largely clandestinely, sending these children (some of whom are adults lying about their age) to various U.S. locations and ordering local school districts to allow them to enroll in the public schools.

_____________________________________________

The above two paragraphs are from a press release from the National Center.

The vaccinations and the documentation of such we have always been required for enrollment and to keep our kids in school, does not apply to illegal immigrants. I don’t know how else to say it, this is total Bull Shit.

If immigrants, legal or illegal make it into this country to live as U.S. citizens, they should live by the laws and regulations of city, county, state and federal government. No exceptions! We the People who are expected and do live by these laws (most of us anyway) should demand no less or no more for immigrants.

How many epidemics will be caused by ignoring the proper enrollment and health requirements for our public schools? It is the children we are to protect. The government only wants to inflict easy answers, easy solutions; just shut up and do as we say! It is an immigration problem they created by not following our immigration laws and securing our borders.

This should not be acceptable to our school districts. Do they have the integrity to stand up to the FED and challenge them on this issue?

It isn’t just Obama and his administration that is to blame, our dead ass Congress has no integrity and are lifeless. Every damn one them should be removed from office.

Once every 2 years, the FAA sponsors a medical education program in Europe for Senior Aviation Medical Examiners. It is a terrific opportunity to learn directly from the top FAA medical leadership. This year traveling to Munich from Oklahoma City and the FAA medical headquarters were 3 senior staff. We learned about the new EKG transmission standards, CACI and special issuance rules, and discussed the future of aviation medicine with our colleagues from all parts of the world.

That is very good news indeed. I’m happy you are satisfied with the results. You should bring the report from the eye specialist as well as completing your Medxpress online application listing it as a surgical procedure.

I look forward to seeing you on your next visit and removing your vision restriction from your certificate.

Best
Ray

On Jun 24, 2014, at 09:14 AM, < xxxxxxxxxxxxxxxxxxx > wrote:

Hey Dr. Basri – how’s things? Hope your summer is off to a good start.

I’m your pilot patient who took your advice and had LASIK performed last November at TLC. Very happy I did – 20/20 or better on each subsequent vision test! My Class I is scheduled with you in July. I wanted to know what documentation, if any, you need me to bring for this physical. It’s my first physical since having the LASIK. Also, can the “corrective lenses” restriction be removed from my medical now?

Thanks for letting me know – I’ll bring whatever documents you need from either TLC or my follow-up exams from my local optometrist. Look forward to seeing you next month.

]]>https://patientstalk.net/go/medical-errors/medical-errors-four-basic-rules-what-you-can-do-about-it/
Thu, 06 Feb 2014 13:29:10 +0000tanyaznamenskayahttps://patientstalk.net/go/medical-errors/medical-errors-four-basic-rules-what-you-can-do-about-it/The definition of a medical error is a subject of debates. According to Wikipedia: “a medical error occurs when a health-care provider chooses an inappropriate method of care or improperly executes an appropriate method of care”. Despite all medical, philosophic or semantic definitions, intuitively we all know: medical errors occur when health providers did not deliver help on time, did not deliver it at all or did it in a wrong way.

My mother was brought to the hospital with the diagnosis of pneumonia. In the evening her temperature reached the mark of 40 degrees. A doctor on duty came and gave my mother a paracetamol injection. There was no effect. The doctor was trying hard to convince me that this is a normal and typical course of pneumonia and that the specialist on this disease would see my mother the following morning.

I had to leave the hospital to come back early in the morning. During the night I got a call from a woman who was sharing the room with my mother. She told me that my mother was just “burning out” so that the room neighbor had to call an emergency. After urgent medical examinations my mother was operated immediately with a diagnosis of purulent appendicitis. Without this woman who relied more on her own observations and common sense and thus doubted the initial diagnosis, my mother would not have survived till the next morning.

My personal case is unfortunately not exceptional. Over 23% of European Union citizens according to WHO report claim to have been directly affected by medical errors, 18% claim to have experienced a serious medical error in a hospital and 11% to have been prescribed wrong medications. Evidence on medical errors shows that 50.0% to 70.2% of such harm could be prevented [1].

The following illustration is an example of a hand-written prescription for Metadate ER 10 mg tablets. Metadate is a drug used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Due to the similarity in name, poor penmanship and the omission of the modifier “ER”, the pharmacy filling the prescription incorrectly dispensed methadone 10 mg tablets. Methadone is a morphine-based product used as a heroin substitution therapy and analgesic. Methadone is not used for the treatment of ADHD [4]

Medical errors affect one in 10 patients worldwide [2]. It is interesting that industries with a perceived higher risk such as aviation and nuclear plants have a much better safety record than health care. According to WHO there is one in 1 000000 chance for a traveler being harmed while in an aircraft. In comparison, there is a one in 300 chance of a patient being harmed during health care procedures [3] i.e. the latter involve over 3.3 thousand greater personal risks (well over three orders of magnitude).

Poor communication between physicians, nurses and patients, improper documentation (e.g., negligence of some of the patients’ symptoms or negative side effects of medical interventions), illegible handwriting, inadequate nurse-to-patient ratios are contributing to the problem. Let us not forget that doctors are also humans: they could be distracted, tired, not that well experienced or properly skilled (especially in specific cases that are countless in such a complex system as a human organism). Not all engineers are leaving colleges with the best grades, why do we reckon that all doctors were good students?

What can we as patients do about medical errors? There are 4 rules I worked for myself.

Rule #1: Ongoing health and medical education is now your almost daily activity.

You do not know how long you or your close relatives have to stay in the hospital and what will happen after. It may turn out that you have to struggle with the disease for many years. There is plenty of information you can find over the Internet today, but it is always good to address professional health resources. I personally quite often use mobile application Health Choices designed by the National Health Services UK (NHS), although I am not a UK based. You can find in this source quite comprehensive information on more than 750 conditions and treatments delivered to your smart phone. There is a similar system in the US developed by the US Center of Disease Control and prevention (CDC). The CDC application provides a mobile public 24/7 access to important health information as regards various chronic diseases, new treatments and research in medicine and healthcare – through scientific articles, popular journals and social media dealing with important health concerns and events throughout the year. Though I am not a US citizen I have still downloaded the CDC mobile application from the Microsoft store and find it quite useful. Both Health Choices and CDC applications are available on Microsoft appstore. I believe one can find similar online services almost in every European country or simply start with Wikipedia.

Rule#2: Go for the second opinion.

One mind is good, but two are better. It is important to have trustworthy relationships with your doctor, but trust should not substitute knowledge. To find a specialist with the profile you need is not an easy task. Normally, the first thing we do is turning to somebody you know. There are, however, some technologies that can help. The mentioned above Health Choices allows the UK citizens to look for a specialist nearby and rate the quality of services they have received. Spanish mobile application, MedCitas, though initially designed as patients’ appointment system, gives a chance to search for professional medical skills and experience required for a particular case. Though local databases (DB) are always richer and easier to access if you are in the same country, there is an attempt to create an international DB. European people travel a lot, and if you happen to land in a hospital abroad it is good to get some background on physicians and available services. Doctoralia is a mobile application where you can search for physicians and medical centers in various countries and get some background on the scope of services they offer. You can even book an appointment if you have found the right specialist. You can also compare the doctors’ background and look how she/he was assessed by the former patients.
If you or your closed one is already in the hospital, it is quite important to have a comprehensive view on the overall conditions of your or your relative’s health. Note that the contemporary mainstream medicine is built on dissecting the entire human body into diseases that can be grouped to form a medical specialty. Each medical professional is focused on repairing a certain part of the body without paying much attention to the integral body status. Such an approach inevitably leads to more and more radical interventions which we, patients, would like to avoid. Ask for the results of a medical consilium. Normally, hospitals are not eager to set up consilums for the sake of costs savings, but in more complicated cases they go for it. Certain advanced clinics (there is a good example in Germany set by Asclepius private chain of hospitals) the “second opinion” process is automated. A patient is invited to a “virtual consilium” with several specialists giving their expert opinion through integrated audio and video systems. Such systems are quite common nowadays. They could be set on Skype, Microsoft Lync or similar systems.

Rule #3: Do not ignore social networks.

No matter how unique or complicated your situation might be, how deep and personal is your pain, you are not alone with it. There are many people like you who have struggled through similar experiences. And when there are thousands and millions, it is already a statistics you may at least consider. Quite accidentally, I recently came across PatientsLikeMe Website. With PatientsLikeMe you can post your profile (or just indicate your areas of interest) and check if there are people who have similar concerns. This tool contains quite a substantial overview of medications and treatment mapped to various diseases verified by a large group of patients. You can also address your problem through the discussion forum and receive an advice from a specialist or a patient like you. Of course there are always heated discussions related to security and privacy, but in this case you yourself is “the master of ceremony”: you are not obliged to disclose what you do not want to.

Rule #4: Do not silence medical error when you witness it.

To report on medical errors is painful and difficult. Not often doctors are open to admit the very fact of a mistake that has damaged a patient’s health. Recently I talked to my neighbor whose brother died as the result of a cardio surgery. What initially seemed like a simple check up on the status of a bypass, turned into an infection that killed this patient. Relatives decided not to report. Typical reaction: what can we do now? Nothing could be changed. But think about others and, who knows, maybe about yourself. We do not want revenge and punishments here. Many medical errors are happening not in isolation, but often as a result of smaller errors that went unnoticed. There are usually several layers of protection and guidance in each hospital to identify an error before it damages a patient. If we as patients do not report on medical errors these layers of the patient safety will be thinner and thinner. Each hospital has a journal where it registers the level of patients’ satisfaction. For some hospitals, it is the essential part of their key performance indicators (KPI) captured by the hospital information system (HIS). Do not be afraid or forgetful to give your feedback to the level of services you have received in the hospital to protect yourself and your beloved ones. In case you feel your complains are going nowhere – share it with the community, use social networks!

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Tue, 21 Jan 2014 08:43:53 +0000royarusthttps://royarust.wordpress.com/go/uncategorized/mens-health/Men and women alike should not underestimate the importance of regular health tests and check ups, especially after a certain age. The earlier problems are identified, the sooner the necessary treatment can be administered. The same goes for investing in life insurance – by investing now, you can prevent any further financial hardships your loved ones may suffer as a result of your death.

Men should have regular examinations and your medical doctor will determine what those are, as well as the tests that should be had, depending on your age and health condition. Recommended tests/examinations:

annual physical

dental check ups

exams for testicular cancer

cholesterol levels

various blood tests

vision exams (from 30s) and hearing exams (from 50s)

other tests for various illnesses depending on age

Even though men tend to shy away from most medical things, they really should be on top of their health, especially later in life and even more so if they are the primary bread-winner of the household. Seek both medical advice as well as advice regarding the right kind of life cover for you. There are numerous life insurance companies who are very helpful and can provide you with all the necessary information, helping you secure your family’s future.